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According to聽from the , superbugs are in the 鈥� and loves a good germ panic . The bugs raising alarm are called KPC (Klebsiella pneumoniae carbapenemase) or CRE (carbapenem-resistant Enterobacteriaceae).
The (pronounced enter-oh-bact-ear-ee-ay-cee-ee) are a large family of bacteria, which largely live as a normal part of people鈥檚 healthy gut bacteria. It includes E. coli as well as some more nasty bugs such as Salmonella and Shigella, which cause gastroenteritis.
A member of the family that doesn鈥檛 get as much press is . It鈥檚 a fairly common cause of infections in hospitals, such as urinary tract infections and pneumonia. Different species also live widely in the environment.
The C refers to a , which is an enzyme the bacteria produces that can the class of antibiotics called carbapenems. are the hospital鈥檚 鈥渂ig guns鈥�, used for patients who are critically ill, or where there is resistance to other antibiotics.
The problem is that carbapenems share a common structure with penicillins and cephalosporins. Together, this family of antibiotics account for of antibiotic use in hospital.
These bugs sometimes carry extra resistance genes which stop other commonly used antibiotics from working. This often leaves which we no longer commonly use (often because they have significant side-effects) as the only treatment option. There have been of bacteria to all available antibiotics, and trials on the best way to treat these bugs are underway.
The first isolates of these bacteria seem to have been imported from or Australians returning home. But these bugs may spread between people relatively easily, especially in health-care facilities. this has occurred in Victoria.
The bacteria seems to have been imported from travellers.

Although these infections may be easily transmitted, becoming sick from them is rare. As the bugs that carry the resistance are similar to normal gut bacteria, they can live there quite happily without causing you any bother. We call this being 鈥渃olonised鈥� by the bacterium. When they get into places they shouldn鈥檛 be (such as your lungs or into your blood) the bacteria can then cause infection. This is more likely in patients who are very unwell, such as people in intensive care units.
Most people who have tested positive for CRE are carrying the bacterium, but are not sick from it. Media reports are therefore with lines such as 鈥渉ave died with a 鈥� superbug in their systems鈥�, which means the patient was colonised rather than infected.
When actual infection does occur, the outcomes are often poor. Intensive care units in Europe death rates up to 50%. This is generally because patients who acquire CRE are very sick before their infection, but are certainly worse for very resistant infections than for more sensitive ones.
Resistance also the cost of care and hospital length of stay, impacting everybody in the health-care system.
New antibiotics are desperately needed to treat these infections. The United States government has announced the 鈥� ten new antibiotics by 2020. Australian are active in this . But antibiotic is a slow process, so in the meantime, a holding strategy is needed.
There are two ways to hold the bugs back 鈥� prevent people from acquiring them in the first place, and slow the development of antibiotic resistance.
is a critical, but often under-appreciated part of our hospitals. And the most important part of infection control is . The hands of health-care workers are critical to the transmission of bacteria between patients. Patients with resistant organisms are often kept isolated, but at least some of the benefit of this isolation comes from prompting health-care workers to clean their hands before and after patient care.
The most important part of infection control is hand washing.

Australia has for infection control generally, and for CRE.
The second key intervention is . Exposing bacteria to antibiotics is the way resistance comes about, and by reducing the use of antibiotics, we can delay resistance. Reducing the use of carbapenem is an important target of stewardship programs, which are now a mandatory requirement for hospitals to be .
The last two years have been a time of rapid development in the fight against antimicrobial resistance. The has increased its focus on resistance, and the Australian government has released its own .
Outbreaks such as this highlight the need for government, academia and industry to work together to help take these plans beyond the summits and discussion papers and into our hospitals. Understanding by and involvement of the public is also crucial.
Only with a united front can we hope to slow the 鈥溾�� of resistance.
References:
, Infectious Diseases Physician, Senior Lecturer, James Cook University and,
This article was originally published on . Read the